What does a DBT session involve?

It is really important that you receive the most effective treatment for you.  In light of this you will need to have an assessment with me so we can agree on your current difficulties and what may be helpful.

The aim of therapy is to provide you with an opportunity to be able to explore your difficulties in a confidential and safe environment. My role, as the DBT therapist is to help you through this in a non-judgemental way.  I will give you information, teach skills and offer suggestions and we will set goals to work towards. If I feel I can no longer help you I will recommend someone who can. I will be clear about what treatment will involve and we will decide together what your treatment plan will be. For example, you might decide you would only like to learn particular DBT skills relating to a certain difficulty.

Each session consists of reviewing work set out of session, diary cards, chain analysis and sharing experience of skills. This is followed by presentation of new skills and a Mindfulness practice. Work out of session is discussed and diary cards are given out for the following week to encourage practice.

If you decide to undergo all of the modules you will receive a DBT Skills Training manual to use and keep which has been written by me drawing from experts in the field. If you decide only to do certain modules you will receive the relevant material for those modules.

DBT Therapists use a hierarchy to prioritise what needs to be worked on in the session. The hierarchy comprises of:

Life Threatening Behaviours

Therapy Interfering Behaviours

Quality of life Interfering Behaviours.

Once the above is agreed with you I will ask you to complete a diary card each week that records your thoughts, emotions & behaviours. A chain & solution analysis is then conducted based upon the behaviour that is rated as the most serious on your hierarchy list.

During this process I will help you to think of DBT skills that you could have used instead of an unhelpful behaviour. We will look at unhelpful ways of thinking that may have added to the situation and look at alternatives.

The sessions will also include skills teaching. The aim of DBT is to offer you the opportunity to learn skills that will help you cope effectively in your everyday life. The skills are helpful in coping with distress and managing thoughts, emotions and behaviours. The skills taught will also help you to have a better chance of getting enjoyment out of life again and moving forward. I will also ask you to keep a skills diary card so that you can keep a record of the skills you are practicing and which ones you find the most helpful.

Sessions follow the skills training modules of Linehan (1993 & 2015) and consist of:

Mindfulness

Distress Tolerance

Emotion Regulation

Walking the Middle Path

Interpersonal Effectiveness

The Mindfulness skills are taught first as they are core to the other skills. All the skills can be practiced individually but the Interpersonal Effectiveness skills require practice with other people, so these are taught last when you may feel more confident. Here is a brief overview of the skills:

Mindfulness

The mindfulness skills help us to be aware of our thoughts, feelings, emotions, and behaviours in the present moment, without judging or criticising ourselves, other people or the experience.  The mindfulness skills help us not to ruminate on our pasts or worry about the future; they help us to be aware of when we are being self-critical and encourage us to do just one thing at a time so we have the opportunity to get more enjoyment out of life and slow ourselves down.

Distress Tolerance

This module looks at accepting and finding meaning in pain and how to tolerate distress skilfully in a healthy, non-harmful way.  Normalising pain as part of life is explored, how it cannot be entirely avoided or removed but how we can learn to tolerate it. How we can learn from pain is discussed and how the inability to accept it leads to increased pain and suffering.

Emotion Regulation

This module looks at the primary emotions of love, joy, anger, sadness, anxiety, shame and guilt, how do we know when we are experiencing these emotions? Once we have labelled the emotion how do we manage it effectively? The link between the way we interpret an event and our thoughts, physical feelings, emotions and behaviours is explored. Secondary emotions are discussed and why we have emotions and how we can recognise and label them. Unhelpful beliefs about emotions are explored and why these can be a barrier in us expressing ourselves. Skills are taught that can reduce our vulnerability to being emotional and reduce suffering, how we can do the opposite to an emotional urge, increase effective emotions and competence.

Walking the Middle Path

This module looks at unhelpful thinking styles, stuck thoughts, how we can shift unhelpful thoughts. It also looks at dialectics, how we can balance acceptance and change. Validation is also explored, how we can validate ourselves and others.

Improving Our Communication

This module looks at social skills training, assertiveness training, listening and negotiation skills. Topics covered are making requests, saying no, balancing our own needs with others’ needs, meeting our own goals, maintaining relationships, keeping self-respect intact and coping with arguments.